1. No category

Editor: Prof. (Brig) Aamir Ijaz
Sub-editors: Dr. Sara Reza, Dr. Maryam Rafiq
Patron
Maj Gen Farooq Ahmad Khan HI (M),
(retired)
Retirement of a Great Teacher
President
Brig Dilshad Ahmed Khan TI (M)
(retired)
Prqfessqr (Brig) Dilshad Ahmed Khao TI(M), Presideot PSCP, has
Vice President
Dr. Samina Ghayyur
Shifa College of Medicine, Islamabad
shad is a gradvate qf first batch qf Arny medical Cqllege Razalrio-
retired after 32 years qf Arny seryice qo 31st Avgwst 2014. Prqf Dildi. He cqmrleted his FCPS io Chemical Pathqlqgz io 1992. Theo he
rrqceeded tq USA aod gqt MS degree io Clioical Tqxicqlqgz frqm
Secretary
Brig. Rizwan Hashim
Army Medical College, Rawalpindi
Uoixersitz qf Illioqis Chicagq. He cqmrleted his research rrqject after
retwrpiog hqme aod gqt a PhD frqm Qvaid-e-A{am Uoixersitz Is-
Council
Prof. Asim Mumtaz
Shalamar hospital, Lahore
lamabad. He svreryised sexeral FCPS, MPhil aod PhD stwdeots dvriog his stay io Arny Medical Cqllege aod AFIP Razalriodi. He zqo gqld medal frqm ‘Pakistao Academy qf
Dr. Sami Saeed
Fauji Foundation Hospital, Rawalpindi
Scieoces’ io recqgpitiqo qf his tremeodqvs research achiexemeots. He zas azarded Fellqzshir qf the Rqyal
Cqllege qf Physiciaos qf Irelaod io 2011, aod io 2013, he had the voiqve hqoqvr qf gettiog Fellqzshir qf the
Prof. Asma Shaukat
Quaid-e-Azam Medical College, Bahawalpur
Rqyal Cqllege qf Pathqlqgists (Lqodqo) zithqvt examioatiqo. Establishmeot qf a state-qf-the-aru Fqreosic
Tqxicqlqgz lab at AFIP Rzr is qoe qf the mqst qvtstaodiog achiexemeots. A zqrkahqlic zhq dqes oqt be-
Dr. Munawar Hussain Marri
Bolan Diagnostic Lab, Brewer Road
Quetta
liexe io zastiog time io aoy oqo-rrqdvctixe actixities, Prqf Dilshad is a rqle mqdel fqr all the stwdeots qf
Chemical Pathqlqgz aod qther discirlioes. He has beeo affiliated zith PSCP sioce its iocertiqo aod oqz as
Dr. Ejaz Hassan Khan
Khyber Medical College, Peshawar
Presideot he has really cqotribvted a lqt io the rrqgress qf the sqcietz. Althqvgh 31 st Avgwst 2014 is a laodmark io the meritqriqvs career qf Prqf Dilshad, he zill be axailable tq his stwdeots aod cqlleagwes io cixil
Dr. Adnan M. Zuberi
Zia-ud-Din Hospital, Karachi
dress qo a xerz imrqruaot arrqiotneot io Razalriodi. We zish him a xerz harry life at his rreseot rqsitiqo.
Inside this issue






Animated chemical pathology
Role of Chemical Pathology in Screening and Diagnosis of Multiple Myeloma
Harmonization- A global effort to improve patient care
Meta-analysis
Accreditation of clinical laboratories
Changing Role of Laboratory Medicine
December 2014
THE SPECTRUM
From The Editor`s Desk
Third issue of The Spectrum is in your hands. In this issue we are lucky to have assistance from Dr Maryam Rafiq who has joined the editorial staff this year. She is the
same Dr Maryam who won the title of Chemical Pathology Laureate in DLP-2. Her
brilliance in literature and IT skills was recognized by Dr. Sara Reza who recommended her name for sub-editorship. We are also greatly indebted to Dr Sara Reza
herself for sparing precious time, so close to her final examination, for this issue.
We dedicate this issue to Prof (Brig) Dilshad Ahmed Khan, President PSCP, who has
just retired from Army service. Once again the newsletter owes its success to the con
tributions from our young colleagues. Their brilliant and creative
ideas were translated into some very interesting printed matter.
For example, the survey appeared in this issue is a masterpiece
from our two sub-editors.
Some very informative articles on ‘Lab Accreditation’, ‘Role of
Lab Medicine’, ‘Warburg Effect’ and ‘Harmonization’ are
useful contributions in the issue.
We are honoured to include an Islamic article in this issue
and beautiful poem on Youth is the first piece of poetry in
the newsletter.
Please go through the article ‘What is in the name’ and give
Your opinion as requested at the end. ‘Brief report on DLP2’ is included to archive this important educational activity
while ‘Animated Chemical Pathology’ is probably the first of
its kind in any Pathology literature.
I hope you will find the issue not only entertaining but also a
source of some useful information. Lastly I want to pay my
gratitude to Dr Qurat-ul-Ain, Dr Uzma Ansari and Dr Amina
Tariq for helping in proof reading and all the people who have
supported ‘The Spectrum’ morally and physically.
Prof. (Brig) Aamir Ijaz
email: [email protected]
The Spectrum‘ and PSCP welcome participants of 3rd Joint Conference of the Societies of Pathology and 7thNational Conference of PSCP from 19th to 21st Dec 2014 at Khyber Medical College, Peshawar
The PSCP sessions will be:
Two Pre-Conference Workshops:
Research Designs in Diagnostic Studies – 18th December 2014 (Thursday) from 0900 h to 1300 h.
Interpretation of ABG Reports – 18th December 2014 (Thursday) from 1400 h to 1800 h.
 Plenary Session comprising talks by senior Chemical Pathologist on 19th December 2014 (Friday)
 Four Scientific Sessions of free papers of Chemical Pathology
December 2014
THE SPECTRUM
Second Edition of Distance Learning Programme in Chemical
Pathology (DLP-2)-Brief Report
During the feedback of DLP-1, many participants demanded that DLP should be continued in 2014, so DLP-2
was started on 19 Jan 2014. The topics were selected after
proper consultation with senior Chemical Pathologists.
Some of the seniors also prepared some lessons and DLP2 is deeply indebted to them i.e. Prof Dilshad Ahmed
Khan, Dr Muhammad Aamir, Dr Naveed Asif
and Dr Zujaja Hina Haroon (AFIP Rwp), Prof
Asma Shaukat and Dr Lubna Sarfraz (QAMC
Bahawalpur), Dr Ayesha Habib Khan and Dr
Lena Jaffery (AKU Karachi) and, Dr Asma
Naseer Cheema (AJK Medical College, Muzzafarabad). A schedule of the lessons with dates
was sent to the participants and lessons were sent
on
alternate
Sundays
without
fail
(Alhamdolillah).The number of participants was quite
higher as compared to DLP-1 and participants` response
was also much more enthusiastic. DLP-2 consisted of 20
lessons and was participated by 78 trainees and 23 consultants out of total 113 registered participants. Lessons
were made in a uniform pattern with 10-12 days for response. The students also contributed in the key presentations and developed an increasing sense of participation
Category: Distant Students
in the programme. Although in some lessons trainees of
AFIP (near students) were allocated topics to prepare
slides, generally participants sent slides voluntarily. In
this regard, contribution from Dr Sabiha Waseem
(Canada) is really commendable. Skype sessions followed each lesson and the number of sessions ranged
from one to three to facilitate the participants.
Connectivity remained an issue in the Skype
sessions but participants never got frustrated
indicating their deeply entrenched interest in
the process of learning. Facebook page of
PSCP was also extensively used for sharing
literature and important announcements. Dr
Usman Munir, a very efficient administrator of
the group, changed the cover picture according
to the running lesson and kept the group alive. At the end
of programme, nine top positions in three different categories were announced based on the total scores earned.
In addition, CME/CPD credits have also been awarded to
the participants at the rate of 5 credit points per lesson.
Facilitators who developed the lessons were given double
credit points i.e. 10 per lesson.
Top position winners of DLP-2 are:
Category: Near Students (AFIP
Rwp)
Category: Junior Consultants
Chemical Pathology Laureate:
Dr. Maryam Rafiq, QAMC Bahawalpur
1st Position: Dr Qurat-ul-Ain
1st Position: Dr Sajida Shaheen, PNS RAHAT Karachi
2nd Position:Dr Farheen Aslam, QAMC
Bahawalpur
2nd Position: Dr Uzma Ansari
2nd Position: Dr Muhammad Anwar Jatt,
CMH Quetta
3rd Position: Dr Sara Reza, QAMC
Bahawalpur
3rd Position:
3rd Position: Dr Saleha Zafar, QAMC
Bahawalpur
Dr Amina Tariq
5
December 2014
THE SPECTRUM
Animated chemical pathology
Here is a very unique way of presenting scientific concepts. We have given life to our favourite substances and molecules. It
may help to remember these ideas besides entertainment
AST –The CheAter:
Heart expelled AST saying “go away cheater -you are also
loyal to the liver” (AST has been removed from the list of cardiac markers because of its nonspecificity). To add to its insult liver also gives preference to ALT on AST because of its relation
with heart. So poor AST is out of heart and liver, on the accusation of cheating. Do we have a lesson
here to learn?
HDL and CETP –The Hero and The Traitor:
‗H‘ for hero and ‗H‘ for
HDL, our hero has a lot of potentials and plays multiple roles – just like Hercules again with an ‗H‘. He
has a lot of enemies to fight with alone e.g. LDL, VLDL, IDL and Lipoprotein (a). He very successfully
fights but unfortunately there is also a traitor in his army and it is Cholesterol Ester Transfer Protein
(CETP). When the hero (HDL) is taking cholesterol away from periphery to the liver, the traitor (CETP)
smuggles some of its cholesterol to VLDL, which becomes a very dangerous particle i.e. small dense
LDL (SDL). In return VLDL gives some cash (triglycerides) to CETP but this money (triglycerides) does
not stay long with CETP and is taken up by the liver by the action of hepatic lipase. So at the end of the
day the traitor is left with nothing and vanishes.
Hepcidin – The Iron Master:
Hepcidin, holding a stick in his hand, has been assigned the duty of controlling the porters of iron
(Ferroportin). On a normal day (with normal Iron levels) the iron master is sleeping in his chamber and
the porters keep on doing their job of transporting iron from inside the intestinal lumen to the enterocytes
(besides other sites). When body has enough iron stock and does not require more iron from intestine, our
iron master (hepcidin) gets a telephone call (from liver) to get up and stop his porters (ferroportin). He
takes his stick and put all these porters in a cellar (internalization). In people with haemochromatosis, the
iron master is off-stick and there is nobody to control the porters, with the result iron is continuously deposited in the body.
TSH –The Worried Mother:
A worried mother (TSH) brings her two sick
children (T3 and T4) to the child specialist. Now whom should the doctor ask to get details?
Mother of course, as children are too innocent to tell about their illness. So if you want to know
something about thyroid disease (dysfunction) ask from mother (TSH) and not from the children
(T3 and T4). The anxiety of mother cannot be compared with that of children. Do you agree?
Fluoride -The RBC Controller :
In a sample tube Sodium (or Potassium) fluoride
addresses the RBCs “ Look gentlemen this glucose
is not for you; so please don`t eat it. Its patient`s
glucose and is sacred for us”. In the tubes without
fluoride, there is nobody to control RBCs and they
party with glucose as the main course!!
Prof. (Brig) Aamir Ijaz,
AFIP, RWP
4
IQ Test Lab

Six drinking glasses stand in a row, with the first three
full of juice and the next three empty. By moving only
one glass can you arrange them so empty and full
glasses alternate?

Fill in the sequence:
prl, my, jn, jly, gst ?
Please see the answers on page 10
December 2014
THE SPECTRUM
TRIBUTE TO PROF DR. AAMIR IJAZ
From
Quaid-e-Azam Medical College
Prof. Dr Aamir Ijaz , for us , he is one of the most exciting teachers we have
come across in our academic career. We feel so grateful to have been taught by
such a diligent and committed teacher, putting his heart and soul into teaching ,
driven by a constant need to give his best in contributing to the enlightenment of
his students all over
Pakistan. Sir Aamir Ijaz has
a way of communi-
cating with his students that
resonated far beyond
what most teachers ever
manage
achieve.
Teaching is not just a job for
him, it is a passion that
flowed from his heart. Not
only he is a great
chemical pathologist but he
also has a way of mak-
ing us think critically, inspire
us, and could make his
lessons resonate within us ,
to
even years afterward. His friendliness , constant motivation and impetus left an
indelible mark in our educational journey . To put it briefly, this has made
him loved, appreciated, and respected by the chemical pathology trainees all over
Pakistan, especially the trainees from QAMC including me who has the privilege
to learn from him over the past couple of years. We salute you Sir, these words
can never be enough to laud your absolute dedication and impeccable allegiance
towards your endeavor !!!
Dr. Sara Khan
2nd year trainee, Chemical Pathology,
QAMC, BWP
Rosalind Franklin
Rosalind Franklin, who was a scientist working in King`s
College London, contributed greatly in the understanding of the
structure of DNA. She came very close to solving the DNA
structure between 1951 and 1953 but her crystallographic
portraits of DNA were shown to James Watson without her
knowledge. On seeing these pictures the solution became
immediately apparent to Watson, and the results went into an
article in „Nature‟ (one of the world`s biggest science journal).
Franklin's work did appear as a supporting article in the same issue of the journal.
Franklin died in 1958 of ovarian cancer probably due to over-exposure to X-Ray
radiations. Nobel Prize in Chemistry was awarded to James Watson and Francis
Crick, for their work in the discovery of the structure of DNA in 1962 four years
I met an old lady,
Her walk was slow but steady.
She said, I was beautiful like
you,
My eyes shown like morning
dew.
My rose like cheeks,
I used to climb the mountain
peaks.
I danced like a fountain flows,
My hair with many glows.
I was so engrossed,
In my youth that I lost.
I lost it in a split second,
Without knowing it ever happened.
Now I am so old
That it is hard to keep the
hold.
My face covered with wrinkles,
I no more see the star with
twinkles.
Time has passed like sand,
Held in the closest fist of
hand,
Leaving behind just lines,
on my face and no other sign.
Leaving the memories good
and the bad,
Which I treasure with a smile
but sad.
I listened to her for a minute
or two
But had to take my own way
too.
Capt (Dr) Sumbal Nida
2nd Year Trainee
(Chemical Path)
AFIP Rwp
December 2014
THE SPECTRUM
Role of Chemical Pathology in Screening and
Diagnosis of Multiple Myeloma
Multiple myeloma (MM) is a cancer of plasma cells in the bone marrow. Normally, plasma cells produce antibodies and play a key role in immune function. However, uncontrolled growth of these cells
leads to bone pain and fractures, anaemia, infections, and other complications.
Criteria for diagnosis — the diagnosis of symptomatic multiple myeloma requires the following:
M protein in the blood or urine, plus
A bone marrow aspirate or biopsy showing that at least 10 percent of the cells are plasma cells or the
presence of a plasma cell tumor (called a plasmacytoma), plus
Evidence of damage to the body as a result of the plasma cell growth, such as high Calcium in the blood,
Renal failure, Anaemia or destructive Bone lesions (CRAB)
Screening Tests:
Serum and Urine Protein Electrophoresis:
Among the laboratory methods available for the separation of proteins, electrophoresis is
a well-established and versatile technique widely used in clinical chemistry. Protein electrophoresis of serum and urine is a sensitive mean of detecting the abnormal monoclonal
proteins found in myeloma. During electrophoresis, intact monoclonal immunoglobulin
molecules will migrate as a sharply defined band called paraprotein. It is almost always
found in association with Bence-Jones protein in the urine protein electrophoretogram.
Quantification of non-isotypic immunoglobulins:
Measuring total concentrations of IgG, IgA and IgM in serum can reveal elevation of a specific immunoglobulin isotype that is suggestive of the presence of a paraprotein. However, the test does not distinguish between the normal polyclonal and abnormal monoclonal forms of a particular immunoglobulin.
Serum urea, creatinine, calcium & albumin:
Many patients with myeloma have myeloma-related organ impairment (ROTI) in which corrected serum
calcium of usually >0.25mmol/l above the upper limit of normal or >2.75mmol/l and serum creatinine of
1.9 mg/dl is suggestive of ROTI.
Tests to Establish Diagnosis:
Immunofixation electrophoresis (IFE) of serum and urine:
Identification of the immunoglobulin isotype of a paraprotein by immunofixation of the
paraprotein band enables it to be classified as an IgG, IgA or IgM molecule. The identity
of the isotype is important in differentiating whether production of the paraprotein is by a
clonal plasma cell disorder, or by a clonal lymphoproliferative condition.
Tests to Estimate Tumor Burden and Prognosis:
Quantification of monoclonal protein in serum and urine:
Concentrations of serum paraproteins below the threshold value are more likely to be monoclonal gammopathy of uncertain significance and those above are more likely to be myeloma.
ßeta-2 Microglobulin:
Beta-2 microglobulin (B2M) is a useful tumor marker for some blood cell cancers, for detecting kidney
damage, and for distinguishing between glomerular and tubular disorders of the kidney. As a tumor
marker B2M test helps to determine the severity and spread (stage) of multiple myeloma and may sometimes be ordered to evaluate the effectiveness of treatment.
6
Dr. Noreen Sherazi,
Agha Khan University, Karachi
December 2014
THE SPECTRUM
Alfred Nobel
Alfred Nobel invented dynamite and made lot of money. In his will, Nobel directed that the
bulk of his estate should be used to award prizes that would promote peace, friendship, and
service to humanity. After his death in 1896, the govern­ments of Sweden and Norway estab­
lished Nobel Prizes in five categories: chemistry, physics, physiology or medicine, literature,
and peace. A sixth category, economics, was added in 1969. Every year, Nobel laureates as­
semble in Oslo or Stockholm on December 10th on the anniversary of Nobel's death. Each lau­
reate receives a medallion, a scroll, and all or part of a cash award currently valued at about
$1 million per category.
An Interesting Case Report
A 64-year-old female presented with generalized fatigue, poor
appetite, and weight loss. She had hepatosplenomegaly and
diffuse petechiae. Her glucose was 1.4 mmol/L, HCO3 : 12
mmol/L, lactate: 28.5 mmol/L (Ref range, 0.5–3.4), and pH
7.24. Urine ketones were trace positive. She also had pancytopenia. Further workup for insulin-mediated hypoglycemia,
growth hormone deficiency, adrenal insufficiency, and vitamin
deficiencies were within normal limits. Bone marrow aspirate/
biopsy confirmed the presence of Epstein-Barr virus-positive
diffuse large B-cell lymphoma of the elderly.
Name the phenomena causing Hypoglycaemia in
this patient and give its biochemical mechanism?
37th annual conference of PAP
2nd joint conference of societies of
pathology
Answer: Hyper-Warburgism. The extreme glucose consumption by the tumor and the paradoxical lactate generation
by the tumor provide compelling evidence for an
increased Warburg effect.
Dr. Sabiha Waseem
Trainee Clinical Biochemistry
Canada
Useful websites




Evolve: Evolve is a one-stop online portal for healthcare educators and students to access
and purchase all of their Elsevier digital teaching & learning materials.
http://evolve.elsevier.com/
Uptodate: UpToDate® is the premier evidence-based clinical decision support resource,
trusted worldwide by healthcare practitioners to help them make the right decisions at the
point of care.
http://www.uptodate.com/home
American Association of Clinical Chemistry (AACC)
http://www.aacc.org/
American Society of Clinical Pathologists (ASCP)
http://www.ascp.org/
7
December 2014
THE SPECTRUM
Harmonization
A global effort to improve patient care
Pre-analytical factors such as vocabulary for the name
of test procedure, patient preparation, specimen collection and transport needs a lot of improvement but these
are not yet internationally synchronized.
T
oday‘s healthcare system revolves around evidence
-based clinical guidelines that frequently rely upon laboratory test results to diagnose an ailment and to determine if
and when treatment is necessary. This situation become
more complicated by rapidly expanding use of EHR as well
as an increasingly mobile population that results in use of
different laboratories for same test at different times. Unfortunately, results of the same test from different laboratories
often show large inter-laboratory variation and decisions
based on these non-uniform test results increase the risk of
erroneous clinical, financial, regulatory, or technical decisions that may have negative impact on patient care. There
is wide agreement within the medical and laboratory community that harmonization of laboratory test results is critical to improve the quality and value of health care system.
Harmonization of clinical laboratory results means that results between different clinical laboratory measurement procedures should be equivalent, within clinically meaningful
limits, to enable optimal use of clinical guidelines for disease diagnosis and patient management.
Harmonization of test results includes consideration of preanalytical, analytical, and post-analytical aspects.
Breaking News
Analytical considerations are the main focus of harmonization efforts by various organizations. The aim is to
have the calibration of all procedures traceable to the
same higher-level reference system and to have a common calibrator that is commutable with clinical samples
for all of its measurement procedures. The conference
of AACC recommended organizing a worldwide approach for prioritizing and managing the harmonization
process. As a result International Consortium for Harmonization of Clinical Laboratory Results (ICHCLR)
was formed to provide a systematic approach for prioritization of clinically important and technically feasible
measurands to achieve harmonization and to formulate
procedures for harmonization of measurands without
any reference measurement procedure was likely to be
developed.
Post analytical aspects include harmonization of reporting units, referenced interval and decision limits. IFCC
working group for reference intervals and decision limits is running a global project to assess potential for
global reference intervals in various measurands. In Pakistan, AFIP is also a part of this multicenter study.
Major (Dr) Qurat-Ul-Ain
IV Year Trainee (Chemical Pathology)
AFIP, Rawalpindi
Structured Assessment of Skills (SAS) in Chemical Pathology
Under the auspices of PSCP we have successfully conducted two DLPs for the improvement of cognitive domains of our students i.e.
recall interpretation and application of knowledge. In the feedback of DLP2 many students demanded a programme of practical training.
So we have decided to organize a skill training programme by the name of Structured Assessment of Skills (SAS) in Chem Path. This
programme will focus on practical aspects including laboratory skills, data interpretation skills, lab and biosafety practices, managerial
skills and soft skills (e.g. communication with patients, staff, clinical colleagues, administrators and venders, ethical issues and professionalism). The collective wisdom of all qualified Chemical Pathologists will result in development of a valid and reliable assessment
format most suitable to our peculiar specialty. All the centers where MPhil and FCPS training in Chemical Pathology is conducted may
participate in SAS and all consultants, supervisors and examiners in Chemical Pathology may participate in preparation and conduct of
SAS. Chemical Pathologists who are presently not on a teaching appointment may contribute in making the questions. SAS will be conducted on monthly basis and it will comprise two components:
Practical which will include „Major Biochemical Practical‟, ‗Quality Control Procedure‟ and TOACS.
Data Interpretation Skills: Every month we may give a test of 10 cases. We will improve the format of this very essential
component and give it a proper name. One suggested name is “Quick Assessment of Data Interpretation Skills –QADIS”
8
Further details of the programme will be communicated later.
December 2014
THE SPECTRUM
Human Heart
A Versatile Thinker
P
resently, we are living in the age of maNEUROCARDIOLOGY explains
terialism and it can also be called the
that, The heart possesses its own
age of anti-spiritualism. Here, the body is split
little brain, capable of complex
from soul which consequently separated heart
computational analysis on its own
from brain. It led to research in the fields of bi(containing more than 40,000 neuomedicine, psychology and social sciences to
rons). Intrinsic cardiac nervous
establish a link between heart and brain. Resystem acts as much more than a
searchers came with unique findings that the
simple relay station for the extrinhuman heart possesses its own kind of intellisic projections to the heart.
gence which affects the brain
in various ways and it is not
Functioning of the heart is not only
(Al-Quran)
just a pumping organ but
in concert with the brain but also
“Do they not think deeply in Quran, or
much more than that.
independent of it. ―The heart in
are their hearts locked up (from
Quran uses ―qalb‖ and ―fuad‖
particular, seemed to have its
understanding it)?”
at various places for heart. The
own peculiar logic that fre(Al-Quran)
word qalaba in Arabic means
quently diverged from the
―to turn around‖, ―to turn upside
direction of other autonomic
down continuously‖. The word ―fuad‖ in Aranervous system responses.
bic means a place of benefit. ―In the ac“The heart seems to behave as if it had mind
ceptance of Islam, heart is the actual thing.
of its own” (Dr Gohar Mushtaq)
When the heart agrees on a change and it is
convinced about a matter, then the whole body
Prophet Mohammad (PBUH) and his companhas no choice except to obey the heart‖. ―Do
ions used to weep while listening to Quran.
they not think deeply in Quran, or are their
Medically it has been proved that it stimulates
hearts locked up (from underparasympathetic system of heart which causes
standing it)?‖(Al-Quran) Its
stimulation of lachrimal glands of eye and causfuel is Tazkiyah (purification)
es tearing (weeping) and stimulation of erector
and Zikr (recitation from Quran
Pilli muscles of skin which causes goose
and remembrance of Allah).
bumps.
The Muslims of today also
need a vaccine of Qur‘an and
Dr Rubina Shafi
Sunnah at least once a day to
Chemical
Pathology and
make their hearts united once
Endocrinology
Dept,
again.
Facilitations
We offer our warmest congratulations to Dr. Syed Talha
Naeem, Agha Khan University, Karachi on passing his
FCPS II exam in April 2014. Wish you a bright future
filled with the promise of a wonderful career.
9
December 2014
THE SPECTRUM
Meta Analysis
Meta-analysis is a statistical procedure that integrates the results of several
independent studies considered to be ―combinable.‖
Meta-analysis would be used for the following purposes:
 To establish statistical significance with studies that have conflicting
results
 To develop a more correct estimate of effect magnitude
 To provide a more complex analysis of harms, safety data, and benefits
To examine subgroups with individual numbers that are not statistically
significant
Conducting meta-analyses
Location of studies: Meta-analysis requires a comprehensive search
strategy which interrogates several electronic databases, hand searching of key journals and checking of the reference lists of papers.
Quality assessment: Good meta-analyses will use objective criteria for
inclusion or rejection of studies on quality grounds.
Calculating effect sizes: Two approaches used are: odds ratio
(previously), and now the risk ratio (relative risk). Ratio of 2 implies that the defined outcome happens about twice as often in the intervention group as in the control group.
Advantages:
To increase power
To improve precision
To settle controversies arising from
apparently conflicting studies or to
generate new hypotheses
Considered as evidence-based resource





Disadvantages:
Difficult and time consuming to identify appropriate studies
Not all studies provide adequate data
for inclusion and analysis
Requires advanced statistical techniques
Heterogeneity of study populations




Checking for publication bias : Examine a funnel plot. It displays the
studies in a plot of effect size against sample size.
Sensitivity analysis A good sensitivity analysis will explore effect of excluding various categories of studies. It may also examine how consistent the results are across various subgroups.
Presenting the findings: Forest plot displays the findings from individual
study as a blob or square, with squares towards the left side indicating
the new treatment to be better, whereas those on the right indicate the
new treatment is less effective. The size of the blob or square is proportional to the precision of the study. A horizontal line (usually the
95% confidence interval) is drawn around each of the studies‘ squares
to represent the uncertainty of the estimate of the treatment effect. The
aggregate effect size obtained by combining all studies is usually displayed as a diamond.
Heterogeneity: A major concern about meta-analyses is the extent to
which they mix studies that are different in kind. Studies can differ on
the types of patient studied, the nature of local healthcare facilities, the
intervention given and the primary endpoint (death, disease, disability). Meta-analyses should test for the existence of heterogeneity with
25% corresponding to low heterogeneity, 50% to moderate and 75% to
high. If heterogeneity is absent, then the analysis employs fixedeffects modelling which assumes that variation seen between studies
is by chance. Random-effects models assume that variation between
studies exists. When the amount of heterogeneity is large, metaregression is introduced to overcome this problem .
10
Dr. Farheen Aslam
4th Year trainee, Chemical Pathology
QAMC, Bahawalpur
Answers of IQ test on page 4

Pour the second glass into the fifth
glass.
sptmbr
Explanation:Name of the months after
removing the vowels - APRIL, MAY,
JUNE, JULY, AUGUST, SEPTEM
December 2014
THE SPECTRUM
Accreditation of Clinical Laboratories:
Stride along the Perfection
C
linical laboratory results are central to diagnosis, risk assessment, management and monitoring of
disease and accreditation is a formal, third party recognition of competence to perform specific tasks. Laboratory accreditation benefits laboratories by allowing
them to determine whether they are performing their
work correctly and to appropriate standards, and provides them with a benchmark for maintaining that
competence. Laboratory accreditation is a voluntary
activity of complete, accurate and objective assessment of laboratory processes and management practices. Accreditation helps laboratories demonstrate their
efficiency, accuracy, and cost-effectiveness while
keeping the main focus on quality and patient safety.
Approved international standards are applicable and
followed by approved accreditation bodies for medical
or clinical laboratories accreditation. International organization of standard (ISO) has developed a laboratory standard for use only by medical laboratories i.e.
15189 (ISO 15189) which is a well-accepted international standard and specifies particular requirements
for quality and competence of medical laboratories.
Other medical laboratories standards are adopted from
Clinical and Laboratory standard institute (CLSI), College of American Pathologist (CAP), The Joint Commission (TJC) and World Health Organization
(WHO). International Laboratory Accreditation Cooperation (ILAC) is a global laboratory accreditation association.
In conjunction with ILAC, specific regions have established their own accreditation co-operations such as
Asia Pacific Laboratory Accreditation Cooperation
(APLAC) for Asian and Pacific Rim laboratories. National accreditation councils and bodies are approved
or affiliated with regional or international accreditation
organizations to provide accreditation service to medical laboratories at national level.
Pakistan National Accreditation Council is the
statutory body, which have been assigned the task of
accreditation of clinical laboratories in the country and
it has already accredited a few laboratories. Medical
laboratory accreditation bodies use standards to assess
factors relevant to laboratory and quality management
system. Usually a pre-assessment visit is scheduled
before final assessment to highlight any area that requires attention with corrective action. At the end of
final assessment a detailed report on evaluation is presented to laboratory to announce the decision about
accreditation. On the basis of report if laboratory fulfils the minimum criteria for accreditation the laboratory is declared accredited and an accreditation certificate and number is issued to laboratory. Later surveillance is carried out to assess the maintenance of competence.
Dr. Sahar Iqbal
Consultant Chemical Pathologist
Dow University of Health Sciences
Karachi
Workshop with Professor Ichihara (Japan) at
AFIP, Rawalpindi
11
December 2014
THE SPECTRUM
Changing Role of Laboratory Medicine
C
linical laboratories represent an area of
healthcare that has always undergone
major changes because of technological advances and
external economic pressures. A hospital laboratory has
to meet the requests for laboratory investigations by
maintaining adequate diagnostic facilities, to provide
professional advice on management of the patient, to
provide laboratory facilities for research projects undertaken by clinicians, to collaborate in the development,
study and control of new methods of treatment, to undertake applied research on pathology problems and to collaborate in education and training of medical and paramedical personnel. Pathology service plays a pivotal role
in the disease diagnosis. With growing dependence on
the laboratory services, more than two third diagnoses
are made by the laboratory workup.
These are the days of economical considerations
and provision of cost effective services. It has been observed that at least, one third laboratory tests are solicited, without their relevance to the patient‘s care.
If the efforts are made in the right direction,
many highly sophisticated and costly tests may easily be
replaced with a
few simple and widely accepted tests. The laboratory-clinic interface is, therefore, of
fundamental importance to ensure that the patient is given high quality care.
In order to fill the need for better quality health care,
avoidance of medical errors and cost reduction, three
strategies have been recommended for supporting and
promoting clinical consultancy in Laboratory Medicine.
It is an era of Evidence-Based Laboratory Medicine
(EBLM) which focuses on the use of diagnostic tests and
the goal of improving patient outcomes. Asking a question is the first step of the evidence-based laboratory
medicine (EBLM) cycle, the other steps being acquiring
the evidence, critically appraising the evidence, applying
the evidence and auditing use of the evidence. Whilst the
main focus of the EBLM cycle is to provide a strong evidence base for use in clinical practice.
Sqn Ldr Muhammad Younas, FCPS (Chem Path)
Consultant Pathologist, PAF Hospital Islamabad
Congratulations!!
Pathology department, QAMC, Bahawalpur
Our heartiest congratulations
to:
 Prof. Asma Shaukat (Quaid
-e-Azam Medical college,
Bahawalpur)
 Prof. (Brig) Aamir Ijaz
( Armed Forces Institute of
Pathology, Rawalpindi)
on taking charge as Head of
Department. Their hard work,
dedication and determination
is an inspiration to young followers. We wish you to attain
many more success and let all
the happiness in the world be
yours.
12
12
First day of Prof. Asma Shaukat as Head of
Department
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Education is the most powerful weapon which you can use to change the world.
(Nelson Mandela)
Wherever you stand, be the soul of that place. (Moulana Rumi)
There is nothing either good or bad, but thinking makes it so. (William Shakespeare)
More the knowledge lesser the ego, lesser the knowledge more the ego. (Albert Einstein)
The highest result of education is TOLERANCE. (Helen Keller)
Dr. Ayesha Siddiqa
QAMC, BWP
December 2014
THE SPECTRUM
What is in the Name!!
Our specialty is not universally known by one name but in different countries different names are used. Following is a list of countries using different names. The list is not only an interesting piece of information but
also a fruit for thought for us:
Clinical
Biochemistry
Albania, Australia, Bolivia, Bosnia, Brazil, China, Denmark,
Greece, India, Iran, Ireland, Malaysia, Nepal, New Zealand,
Norway, Paraguay, Russia, Singapore, Slovak Republic, South
Africa*, Spain, Sri Lanka, Thailand, UK*, Vietnam
Clinical
Chemistry
Austria, Belgium, Canada, Egypt, France, Finland, Germany,
Greece, Hong Kong, Hungary, Indonesia, Italy, Japan, Kenya,
South Korea, Mexico, Morocco, Holland, Nigeria*, Portugal, Saudi
Arabia, Slovenia, Sweden, Switzerland, Turkey, USA
Chemical
Pathology
Pakistan
*In some countries the names of their associations contains Clinical Biochemistry but Chemical Pathology
is also used in hospital and university labs.
Isn`t it astonishing that Pakistan is the only country, which is using the name of ‗Chemical Pathology’ for
this specialty. Should we consider a change of name? Let us start a national debate on it. Please send your
opinion at any of our emails.
5th PSCP CME course at AFIP, Rawalpindi
13
December 2014
THE SPECTRUM
THE SPECTRUM SURVEY
A
s a Kid what did you want to be
when you grew up? And how you
ended up becoming a chemical
pathologist?
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pathology so I decided to be a trainee of madam
Asma, MASHALLAH a very co-operative and
nice teacher.
(Dr Kamran QAMC)
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I always wanted to be a doctor. During 1st year
of MBBS I decided to do Mphil in anatomy as I
observed the easy and relaxed life of anatomy
teachers. But in 3rd year. I started making my
mind for specialization in pathology. (I still re
member the very first lecture of Pathology was
taught by Prof Asma shaukat. When Ma‘am in
troduced herself I was so inspired and told my
friend, that one day I will be like her and now
Alhumdulillah I am her trainee and I am proud of
it. (Dr Nudrat Khan QAMC)

My childhood dream was to become a nuclear
scientist but I changed my mind just to fulfil the
more prestigious wish of my mother to become a
doctor. After joining army, I felt pathology, being
an emergency free field, was the most suitable for
me. In pathology I love chemical pathology
because of its vast canvas and closeness to
medicine.
(Dr Qurat-Ul-Ain AFIP)
As a kid I wanted to be a lawyer or justice but
when I was not allowed to adopt the profession I
took MBBS as second option which was wish of
my parents as well. I chose chemical pathology
for specialization because It is an interesting field
and of course impressive personality of my
supervisor made me join chemical pathology
( Dr shahnaz Noor QAMC)
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As a kid , it was my very " own " dream to become a doctor and I became a chemical
pathologist by choice as well. On realizing the
fact unlike other fields , there is still quite a lot of
opportunity for females to excel in this emerging
speciality. I then decided to take pathology part 1.
(Dr Sara Khan QAMC)
As a child, I always wanted to be a scientist. As I
grew up, I chose to become a doctor as it was
suggested by my parents. I chose Chemical
Pathology because it is a vast and dynamic field
which also touches other fields of science besides
the medicine.
( Dr Masud Ansari QAMC)
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As a kid I had not as much defined goals, just had
an inspiration to be a doctor. Ending up in chemical pathology was such a sudden decision of my
life. I could not exactly figure out how I joined
this field. May be I felt I can‘t cope with the
hectic duties of medicine. I thought to opt a field
in which there is an easy life style plus more
chances to progress, as chemical pathology is
relatively less saturated.
(Dr Faghia Shahid QAMC)
I wanted to become everything but a pathologist!!
On a serious note I entered in the field of Pathology because of AFIP and in Chemical Pathology
because of inspiration from Maj Gen Farooq Ahmad Khan (retd), my teacher and mentor.
( Prof Aamir Ijaz)
I wanted to become doctor like my ideal mother .But I was inspired by my (late) father who
was Professor of Chemistry, so the interest of
being a doctor and Chemist turned out to be an
amalgam—―chemical pathologist‖
(Asma Shaukat )
I wanted to be a doctor and fortunately was lucky
enough (but off the record sara josh thanda par
gya .it was a stressful time .UHS exams tu bas
tension he tension thi). As I am a native of Bahawalpur and the only good option here is chemical
14
December 2014
THE SPECTRUM
W
hy Female doctors Opt chmemical
Pathology more than male doctors??
ture so females opt Chemical Pathology more
than male doctors.
(Dr Ayesha Siddiqa QAMC)
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Because
they get ample time and sufficient money
to shop dopattas, angrakhas, choridaars and plas- 
mo? (What is the name of that very loose trouser?
I am sorry I forgot) etc.
( Prof Aamir Ijaz)
It goes very well with their family lives
(Prof Asma Shaukat)
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The reason may be 3-fold; either the females are
never scared of difficult things so they love to be
in this challenging field or they are too innocent to
understand the dire needs of this specialty or like ,
me they love the duty hours of this field.
(Dr Qurat-Ul-Ain AFIP)
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Chemical Pathology is all about colors and I
think females reflect the colored side of na-
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Yes it affects because LAURELS is more
important than friendship!!! But hold on, there is
another problem here. Some wise person once
said ―the friendship which ended was, in-fact,
never there”
(Prof Aamir Ijaz)
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I think female doctors prefer the basic medical
sciences over the clinical fields as they also have
to look after their families. Chemical pathology
has good scope and offers opportunities to progress for young pathologists.
(Dr Masud Ansari QAMC)
As females have a double job in their lives i.e.
looking after their homes and kids and to excel in
their carrier so chemical pathology is a field which
provide you both opportunities
(Dr Faghia Shahid QAMC)
C
ertainly, DLP improved our
knowledge and had a vast impact on
our understanding, did it affect your
friendships??
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DLP has created the atmosphere of competition
among trainees and ironically it has created a
lethal atmosphere of jealousy as well ....LOLz
(Dr Nudrat Khan QAMC)
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DLP had an indirect impact on our friendships. It
helped us to differentiate our real friends from the
rest.
( Dr Masud Ansari QAMC)
Yes, I am more friendly with my juniors
( Prof Asma Shaukat)
Ahhmm! "kyun pakki dushmani karwani hai"…
just kidding. Certainly not, rather DLP helped us
in making more friends that was nearly impossible
otherwise.Thanks to DLP we all are now a family.
(Dr Qurat-Ul-Ain AFIP)
No my friendships are all the same: D
(Dr Sara Khan QAMC)
Comfortable working environment makes them
choose chemical pathology.
Dr Sara Khan QAMC)
Yes, it created an environment of competition
among my friends so had a great effect on friendships.
( Dr sumbal Rani QAMC)
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DLP provided a platform where PGRs all over Pakistan and abroad became familiar and developed
good relationships with one another like a family.
( Dr Tahira Jabeen QAMC)
15
December 2014
THE SPECTRUM
16